Earlier this month, President Obama pushed the benefits of the healthcare law, including a promise to cover uninsured Americans who could not get coverage due to a pre-existing condition by July 1.
While the federal government has made good on its promise to run high-risk insurance pools in the 21 states that elected to let HHS run their plans, many of the 29 states and the District of Columbia are still working out the particulars of their programs with HHS.
Oklahoma Insurance Commissioner Kim Holland said her department was still negotiating the final details of their contract to run a high risk pool with HHS, and that the short timeline her department had to set up the program was challenging.
"This is not just a burden on states, but also on HHS," said Holland, who also serves as secretary-treasurer of the National Association of Insurance Commissioners. "We are doing the best we can with what we have."
And although Democrats are eager to see the high-risk pools operational as quickly as possible, many were realistic about states needing more time.
"We need to get this in place as quickly as possible, so people who have pre-existing conditions and don't have insurance should have an opportunity to buy into a high risk pool," House Energy and Commerce Chairman Henry Waxman said, "but some states are faster than others."
Rep. Eliot Engel, D-N.Y., a member of the House Energy and Commerce Committee, said states should take their time to set up plans. New York has opted to run a high risk pool, but does not have an existing state-level program to mirror.
"I think more time's probably needed," said Engel. "It's difficult to rush this thing along, and I think we've got to be careful and cautious in the implementation of it."
Iowa Democratic Rep. Bruce Braley, who said he had recently met with his state's insurance commissioner, said he thought Iowa was in a better position to implement the high-risk pools because the state's insurance department runs a high-risk plan.
"My sense was they were further along in putting a plan in place," said Braley, "they are in better shape than some of the other states in meeting the deadline."
Holland agreed that already having a high-risk plan operational made implementation easier. "We are fortunate to have an existing plan, it is a definite advantage," said Holland.
But regardless of where states are in the process of setting up the high-risk pools, members expressed concern that the $5 billion provided to the fund would not be adequate to support those who have been uninsured for six months or more due to a pre-existing condition, as the law stipulates. CBO last week estimated that the high risk pools would have to be capped at 200,000 enrollees to remain within the $5 billion limit. If the fund was unlimited, CBO estimated that 400,000 people would be enrolled in 2011, at a cost of $10 billion to $15 billion.
Senate Health, Education, Labor and Pensions Chairman Tom Harkin gave a resounding "oh, yes," when asked if he thought the high risk pools would need more money in the future.
"Well, I know some states have some concerns about whether or not there's enough money for the high risk pools. The fact is, if we need more money, we're going to have to come up with it," Harkin said, "one way or another."
Waxman agreed that the program would have to be monitored to ensure it has enough funds to cover all those intended.
"We'll have to take a look at it, because we wanted people to be able to get their insurance from these high risk pools before the whole system was implemented in 2014, and if we need to put more money into it, we'll see if that's plausible," Waxman said.
Braley said Congress would likely have to address the programs once they started fully operating.
"It's like many things we do here. I think we are hopeful that states are going to progress to a point of implementation, and then we deal with the aftermath," said Braley.
Rep. Michael Burgess, R-Texas, floated another solution to funding the high-risk pools.
"Why not work with states that have existing funding pools and provide, if necessary, some additional federal assistance, ask the private sector to provide some additional assistance, whether it be in the form of a direct subsidy or a premium cap," asked Burgess. "These were things that were within our power."
"No one really knows what the correct answer is for funding [the high risk pools]. I can tell you it's not $5 billion, and I think we'll find that relatively quickly," said Burgess.